1 Title: Clinical Study of Thirty Patients with Parkinson Disease and Associated Pathology , Authors: Castejón OJ*, Galindez P, Salones de Castejón M
Abstract We have clinically examined thirty patients with age ranging between 39 to 85 years old. We observed resting Tremor and Brakykinesia in 100% of patients examined and a family history of Parkinson Disease (PD) in 12%. We have found the following comorbidities: arterial hypertension 21%, diabetes 21%, language disorders 21%, neurobehavioral dysfunctions: 12%, neurosensory disorders, (hypoacusia) 12%, dizziness 8%, respiratory diseases 8%, constipation 8% and sleep disorders 8%. The following risks factors environmental conditions, stress, toxics, and previous cerebrovascular accident (1%) were observed. Parkinson disease motor and non-motor symptoms are discussed in details. PD can be associated with nneurobehavioral disorders (depression, anxiety), cognitive impairment (senile dementia), autonomic dysfunction, stress and aggressivity. PD ethiopathogenesis remains to be elucidated and has been connected to genetic, environmental and immunologic conditions. A differential diagnosis of PD with atypical parkisonian syndromes, such as progressive supranuclear palsy, multiple system atrophy, Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration (CBD) is included. DOI: 10.52916/jmrs214043
2 360 Degree Twisted Transverse Colon in a Neurological Impaired Girl with a History of Chron-ic Constipation-A Case Report , K. Karavdić*, E. Milišić, I. Abdagić, A. Smajić, A. Mešić, D. Udovičić-Gagula
Introduction: Transverse colon volvulus is an uncommon cause of bowel obstruction. Predisposing factors are mental retardation, dysmotility disorders, chronic constipation, and congenital megacolon. Case report: We presented a transverse colon volvulus in a 14-year-old girl with mental retardation. Chronic constipation in neurologically impaired patients was a risk factor predisposing to volvulus. The girl was admitted to our Clinic because of problems that last 4-5 days and was followed by abdominal pain, vomiting and lack of stool. Vomiting was once a day. She was sub febrile up to 37.6°C. On examination, the abdomen was distended, tense, diffusely painful. During the surgery, a 360° clockwise volvulus of the transverse colon was found. After the reduction of volvulus, an enormous transverse colon was resected and protective ileostomy was formed. In the postoperative period, ileostoma functioned a good. The definitive surgical treatment was done on the 20th postoperative day when the occlusion of the ileostomy and transanal biopsy of the rectum was done, which showed the presence of ganglia cells. The patient was discharged from our institution after 1 month. Conclusion: Pediatric patient with neurological conditions and mental retardation present an increased risk of colon transversum volvulus due to chronic obstruction
3 A Retrospective Analysis of Weight Loss Associated with the ORBERA Intragastric Balloon at a Single Bariatric Center , Vamsi Reddy*, Nitish Sood, Jennifer Hua, Christ opher Ibikunle
Background: Lifestyle modification and dietary management have proven to be ineffective in the treatment of obesity. ORBERA Intragastric Balloon (IGB) system, a treatment modality approved by the US Food and Drug Administration has recently become available commercially for the treatment of refractory obesity in patients with Body Mass Index (BMI) of 35-40. Setting: A private clinic based in the United States. Objectives: Data on the effectiveness and accommodative adverse effect of ORBERA IGB are currently limited. The objective of this study is to measure the effect of IGB on weight loss, assess the accommodative adverse event safety profile and examine factors associated with accommodative symptoms such as nausea and vomiting. Methods: A review of records of 22 patients treated using ORBERA in a private clinic from September 2016 to January 2018 was conducted. The balloons were filled with 400-600 mL of saline solution. The IGB was placed and removed endoscopically over a treatment period of 6 months. Results: The sample size comprised of 18 (81.82%) females and 4 (18.18%) males with a mean age of 49.23 (range 21-76 years). The most common comorbidities in this population were gastroparesis (4, 20%), hiatal hernia (6%29%), diabetes mellitus (3%-15%), and cholecystitis (2%-10%). The baseline mean weight was 239.26 lb (range 158 lb-323 lb), baseline mean BMI was 39.48 (range 29.85-48.90).The mean end of treatment weight was 182.2lb (range 134 lb-279 lb) with a mean weight loss of 32.2 lb (range 16 lb-48 lb) and a mean BMI 30.79 (range 25.3- 40.2) at end of the 6 months treatment period. No serious adverse events were observed during the endoscopic placement and removal of the system. The most frequent accommodative adverse events were nausea 13 (65%), vomiting 12 (60%), reflux/Gastroesophageal reflux disease 8 (40%). No significant characteristics associated with the accommodative side effects (e.g. nausea and vomiting) were discernible. Conclusion: The findings suggest that ORBERA IGB is an effective, safe and reasonably well-tolerated management option for obesity as significant weight loss was found consistently in the study population. However, further study is recommended for a better understanding of the accommodative symptoms associated with the IGB system
4 Experience of Component Separation Technique with Open Posterior and Endoscopic Assisted Laproscopic Approach in the Management of Large Midline Ventral Hernias , Anchit Kumar, Naveen Kumar*, Romesh Lal, Umesh N
Background: A novel technique of posterior component separation using transversus abdominis release has been propagated to recreate the midline (Linea alba) in patients with large midline incisional hernias and provides a large space for placement of an underlay mesh. Another recent technique popularized by minimal access surgeons is the endoscopically assisted anterior Component Separation Technique with laparoscopic intra-abdominal composite mesh repair. Method: In our study, we did open Component separation by the posterior approach for the first fifteen patients and Endoscopic assisted component separation with laparoscopic meshplasty for the next fifteen patients. A minimum component separation index from the data of the first fifteen patients was calculated using pre-operative CECT scans validating the requirement of component separation index the endoscopic group of patients. All the repairs were reinforced using a prolene or composite mesh as a standard practice. Result: The wound complications were more with the open technique while the endoscopic procedure was associated with lesser blood loss and faster post-operative recovery. Improved functional and cosmetic outcomes were observed in both groups. Conclusion: The component separation done by either a posterior open or endoscopic technique results in good functional and cosmetic outcomes for the patients with no reported recurrences.
5 Safety of Laparoscopic Surgery in Elderly Population in Manila Doctors Hospital, 2016-2018 , Loveline R. Pallera*, Roehl C. Salvador
This study is intended to assess the safety of Laparoscopic surgery in the elderly aged 60 years and older in terms of mortality and morbidity in Manila Doctors Hospital. Since elderly patients are more prone to complications due to the body’s physiological changes and comorbidities. From January 2016 to December 31, 2018, all patients aged 60 years and above who underwent Laparoscopic Cholecystectomy, Laparoscopic Appendectomy and Laparoscopic Hernia Repair were included in the study. Physiologic and operative scores using P-POSSUM and estimates of patient-specific postoperative complications after the surgical procedure using ACS NSQIP risk scoring were used. The overall morbidity and mortality outcome was compared with a choice of international studies. A total of 273 elderly patients underwent laparoscopic surgery. Mostly, 53.1% of the population were 60 to 64 years old who underwent cholecystectomy procedure. The study showed that laparoscopic procedures were safe in the elderly patient despite the challenge that the older population has decreased physiologic reserved and with multiple comorbidities. Among 273 elderly patients, only 3 patients had complications. 2 or 0.74% had pneumonia and 1 or 0.36% died.
6 Clinical risk management, Areas of Intervention, Measures and Tools for Safety Places of Care , Maria Carmen Agnell* Maria Carmen Agnell
In the current socio-economic context, health structures have to address the impact of emerging technological innovation and epidemiological changes on health risk management. In this context, the article analyses the regulatory framework and the set of programming measures and strategic actions in a comparative and diachronic way, in order to highlight what has changed and what needs to be changed in ensuring safety in health facilities. In this process, the turning point is identified in the implementation of the safety culture, through involvement and coordination between the institutional, professional and welfare levels.
7 Fungal Isolates in HIV Positive and Negative Subjects Attending Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka, Anambra State, Nigeria , Ndidi Ethel Nkwoemeka, Chris Okwudili Anyamene, Izunna Somadina Okwelogu, Paschal Chiedozie Amakiri, Chisom Godswill Chigbo, John Osilumie Dirisu
Background: Fungal pathogens are the leading cause of severe healthcare-associated infections in immunocompromised patients, especially from low-income countries like Nigeria. Acquired Immunodeficiency Syndrome (AIDS) arising from HIV infection is reputed to be a key in immune suppression globally. Presently, Anambra state is number 5 in HIV prevalence in Nigeria. This study was aimed at screening patients from the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, for fungal infections. Samples were collected with consideration to gender, age, occupation, education status and clinical presentations. Methods: Sampling was done according to global best practices. Patients’ consent and details were obtained by signing a consent form and filling of questionnaires respectively. Key questionnaire details included sociodemographic and personal details, history of present illness, clinical signs and symptoms. All patients were screened afresh for HIV-1 and HIV-2 using an immuno-chromatographic technique with Determine kit (Alere, Japan) and Stat-pack kit (USA). Specimens screened include Urine, Blood, Oropharyngeal swab, Skin scraping, and Sputum. All samples were labeled, transported and processed within 1-2 hours of collection. Results: A total of 1200 participants (610 males and 590 females) were examined. About 16.5% and 54.41% of the subjects examined were positive for HIV infections and fungal infections respectively. Overall, 233 males (19.41%) and 420 females (35.0%) had fungal infections. Fungal infections were most prevalent in patients between 30-39 years, 17.75%, followed by 40-49 years (15.0%). Infection was least prevalent in patients between 15-29 years at 5.0%. Farmers had the highest prevalence rate of fungal infection, though not significant when compared with those of traders, artisans and public servants (X2 =0.621; df=2; P>0.05). Candida species were the most prevalent fungal pathogen, accounting for 609 (67.1%) followed by Aspergillus spp. 234 (25.8%) and Cryptococcus species 31 (3.4%). Penicillium and Fusarium spp. were the least prevalent pathogens (1.9%). Oropharyngeal candidiasis was the most common fungal infection (49.9%-17.4% HIV negative and 32.46% HIV positive patients); followed by Pneumocystis pneumonia (28.80%-9.50% HIV negative and 19.30% HIV positive patients). Similarly, Cryptococcal meningitis was the least recorded infection at 16.81% (6.43% HIV negative and 10.38% HIV positive patients). Significantly, fungal infections were more prevalent in HIV infected patients (62.14%) compared to HIV negative patients (33.33%). Conclusion: This study has revealed that HIV positive and negative patients are often affected with fungal infections in Anambra State, Nigeria. This may have contributed to impaired immune system in patients and development of AIDS in HIV infected patients. Poor personal hygiene and intimate association with household pets among subjects examined were the suspected sources of infection. Therefore, there is an urgent need for improved surveillance and monitoring of fungal infections in the area and in other Teaching Hospitals in the country as well as treatments of infected subjects.
8 Does BCL-2 Play Role in the Pathogenesis of Primary Oral Mucosal Melanoma? , Ricardo Hsieh, Silvia Vanessa Lourenço
Primary Oral Mucosal Melanoma represents 0.2 to 8% of all melanomas and 0.5% of all oral malignant neoplasia. The etiology still unknown, however, it has been suggested that head and neck mucosal melanomas change their genetic and metabolic pathways through intracellular cascades, which are associated with its etiopathogenesis mechanisms. The BCL2 protein is an integral part of the cell membrane, and it is also found in the cell nucleus, mitochondria, and endoplasmic reticulum. It is overexpressed in several malignant neoplasms, including cutaneouse ocular melanomas. Among all evaluated cases, we found positive immunostaining of BCL-2 in 26/34 (76.47%) and they had a membrane and cytoplasmic pattern, and the intensity was variable. According to our results and the findings of the literature, it can be suggested that BCL-2 has an important role in melanoma pathogenesis, including Primary Oral Mucosal Melanoma and also melanoma metastases. It seems that BCL-2 could be an adjunct marker for POMM and also a target for treatment development. New researches involving BCL-2 and a larger primary oral mucosal melanoma cohort could corroborate the present study
9 Communication Risk: Preventive Measures and Proactive Value-Based Health-Oriented Tools , Author: Maria Carmen Agnello
This article analyses the different profiles related to communication risk, such as all errors, adverse events, that occur within the care path. In this respect, an analysis of a variety of factors shows a twofold trend. Innovation is a level that can positively influence communication risk, on the other hand, towards deospedalization towards multiple forms of taking charge at territorial level require a multi-factorial communication based on different channels. Based on this dual perspective, the article analyzes the set of organizational measures planned and implemented in a preventive and proactive key in the different dimensions of communication both and public. This analytical path is to be modulated concerning the different objectives pursued by communication in health both in ordinary times and emergency through the management of information in the different institutional and organizational levels involved.
10 An Uncommon Presentation of Li Fraumeni Syndrome   , Humaira Haider Mahin*, Matthew Beck, Toni Palasovski and Sarbar Napaki
We report a case of Li Fraumeni Syndrome (LFS), where our patient was affected by two malignancies before the age of 30: chondroblastic osteosarcoma and unilateral breast ductal carcinoma in situ. Her daughter was diagnosed with adrenocortical carcinoma at the age of four, and her mum was diagnosed with cervical cancer when she was in her 20’s. After her daughter’s cancer diagnosis, she and her family members underwent genetic testing. She and her daughter were found to have Tumour Protein 53 gene (TP53) mutation suggestive for Li Fraumeni Syndrome (LFS). Patients with LFS should be managed with a surveillance program with minimal exposure to radiation therapy due to their high risk for second primary cancer. This report will make the clinician aware of this syndrome for early diagnosis and management.
11 Physiochemical Standardization of Kushta Nella-Tutia: A Versatile Drug   , Sumera Mehfooz1*, Imtiyaz Ahmad Mir2, Abdul Wadood3, Hamidudin4
Introduction: Kushta Nella-Tutia has a wide range of Pharmacological actions in Unani system of medicine. It is used both internally as well as externally. In Unani system of medicine, it is commonly used for Qatil e-deedane-am’a (Anthelmintic), Mundamil qurooh (Healing of wound), Aatishak (syphilis), Juzam (leprosy), Qarha asir al indimal (Indolent ulcers), Nawasir nafidha (Fistula). Methods: Kushta Nella-Tutia has been evaluated by using classical, organoleptic and physicochemical tests. The methodology was followed according to the protocol of ASU drugs. Results: Physiochemical results revealed that Kushta Nella-Tutia is Black in color, odorless, lusterless, tasteless and soluble in organic solvents, but insoluble in water and all the physiochemical standards were set. Conclusion: The present study has provided evidence-based scientifically validated data for the standardization of Kushta Nella-Tutia and will serve as a useful tool to minimize adulteration and substitution of Kushta Nella-Tutia. The standardization of herbal drugs is very important for quality control. it improves the efficacy and safety of the drug. Physiochemical results of Kushta Nella-Tutia will serve as a reference standard for identification in the future and the intern will prevent adulteration and improve the quality, identity, and purity of the drug.
12 COVID Diaries: An Indian Perspective , Gurmeet Singh Sarla*
COVID-19 has shaken up the world and these COVID times have allowed us to slow down, log out, switch off for a while and think about our real needs against greed. The ‘lockdown’ has provided us with an opportunity to pursue our hobbies and passion, to learn a new skill, to read your favorite books, watch movies which you have missed, to work-out which you missed doing due to paucity of time and to sit back and think about how to improve and make ourselves a better person. Most of us can work from home and if we are determined, we can cut down on our travel thus reducing air and water pollution in addition to a significant reduction in the number of road traffic accidents. The health crisis brought every one of us together and Corporate India shouldered its corporate social responsibility, reel heroes and cricket legends played their part well and Corona warriors led the war against the virus with grit and determination under the able leadership of a dynamic Prime Minister.
13 Acutely Inflamed Mamilla - Mastitis and Abscess , Anubha Bajaj*
Mastitis is an inflammation of breast parenchyma, predominantly occurring in the breastfeeding period, with or without accompanying infection and appears as lactational or puerperal and non-lactational as is associated with duct ectasia. Breast abscess is a focal accumulation of purulent substances within the breast parenchyma emerging as a complication of mastitis and is common in lactating women. Comprehensive incidence of mastitis is around 33% whereas breast abscess arises in approximately 3% to 11% of subjects with mastitis. An estimated two fifths (40%) of breast abscess or certain breast infections are poly-microbial and specific aerobes such as Staphylococcus, Streptococcus, Enterobacteriaceae, Corynebacterium, Escherichia coli and Pseudomonas along with anaerobes as with Pepto-streptococcus, Propionibacterium, Bacteroides, Lactobacillus, Eubacterium, Clostridium, Fusobacterium and Veillonella can engender the disease. Subjects with mastitis enunciate flu-like symptoms with malaise, myalgia, fever, mammary pain, decline in milk egress, local warmth, tenderness, firmness and swelling of breast region and localized erythema. Breast abscess usually delineates mammary pain and/or a breast lump. Lactational breast abscess morphologically recapitulates an acute inflammation whereas non-lactational breast abscess is commonly sub-areolar and appears as a fistula of lacteriferous ducts, eventually emerging as chronically draining sinuses and breast abscess adjacent to the areola. Squamous metaplasia of lacteriferous duct epithelium, duct obstruction, and sub-areolar ductal dilatation or duct ectasia can ensue.
14 Laparoscopic Treatment of a Patient with Perforated Jejunal Diverticulitis , Francisco J. Buils Vilalta*, Juan José Sánchez Cano,Joan Domènech, Rosa Prieto Butillé, Elisabet Homs Ferré, Elia Bartra Balcells, Pilar Martínez López, Carla Morales Tugues, Mariale García Durán, Daniel del Castillo Déjardin
Jejunal diverticular disease is a rare but important clinical entity. Jejunal diverticula usually remain asymptomatic in 60-70% of cases and cause symptoms or surgical complications in 10-19%. Perforation of a jejunal diverticulum is infrequent and treatment has traditionally been exploratory laparotomy, with resection of the affected intestinal segment. However, the laparoscopic approach can be a good alternative in these cases, providing the known advantages of this type of surgery. We present the case of a 75-year-old man who manifested himself as an acute abdomen and who was diagnosed and treated for a jejunal diverticulum perforation by laparoscopic surgery, with good results.
15 A Case Study of the Relationship Between Weight and Glucose Using Math-Physical Medicine , Gerald C. Hsu*
The article is a case study of the Relationship between Weight and Glucose Using Math-Physical Medicine. For 2,245 days, the author, who has Type 2 Diabetes (T2D) for approximately twenty years, collected and processed about 1.5 million biomedical data regarding his health and lifestyle conditions, including 13,470 data for weight and glucose. There are approximately 20 influential factors (5 for FPG and 15 for PPG) for determining glucose levels. Also, the author has collected a complete set of PPG data for 1,075 days with 3,225 meals. In this article, the author will discuss the specific relationship between weight and glucose along with FPG and PPG. In conclusion, Based on the case study of this overweight but not obese (BMI < 30) patient’s data analyses, the results show that most of his FPG data (~93%) are almost directly proportional to his weight change according to a “fixed” slope.